Healthcare Provider Details

I. General information

NPI: 1396712238
Provider Name (Legal Business Name): ANNE VAN DYKE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4171 NATHAN W
STERLING HTS MI
48310-2650
US

IV. Provider business mailing address

4171 NATHAN W
STERLING HTS MI
48310-2650
US

V. Phone/Fax

Practice location:
  • Phone: 248-660-5034
  • Fax:
Mailing address:
  • Phone: 248-660-5034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301005409
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: